Comparison of postoperative analgesia use between robotic and laparoscopic total hysterectomy: a retrospective cohort study

Although robotic and laparoscopic total hysterectomies are widely used as minimally invasive procedures, consensus on which is superior regarding lesser postoperative pain is lacking. This study determines whether there is a difference in the proportion of postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen between robotic and laparoscopic total hysterectomies. This retrospective cohort study enrolled patients who underwent robotic or laparoscopic total hysterectomy for uterine fibroids, adenomyosis, or cervical intraepithelial neoplasia grade 3 at a hospital between July 2016 and November 2021. The outcome was postoperative analgesics (i.e., NSAIDs or acetaminophen) use. Unadjusted and adjusted logistic regression analyses were performed to evaluate the association between the procedure and outcome. Adjusted variables were age, body mass index, surgeon's laparoscopic technique certification, intravenous patient-controlled analgesia, and wound local anesthesia. Of 127 patients, 3 were excluded, and 124 were included. Robotic and laparoscopic hysterectomy was performed in 38 and 86 patients, respectively. Postoperative analgesics were administered to 10 (26.3%) and 52 (60.5%) patients in the robotic and laparoscopic groups, respectively. Unadjusted logistic regression analysis showed significantly more frequent analgesics use in the laparoscopy group (odds ratio [OR] 4.28; 95% confidence interval [CI] 1.85-9.93; p < 0.01). Adjusted logistic regression analysis did not detect significant differences (OR 2.62; 95% CI 0.91-7.56; p = 0.07). No significant difference in the proportion of postoperative analgesia was observed between robotic total hysterectomy and laparoscopy. Future studies must include larger sample sizes and aligned intraoperative and postoperative analgesic management.